Author(s): Brixner D, Biltaji E, Bress A, Unni S, Ye X,
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Abstract OBJECTIVE: To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients. METHODS: An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources. RESULTS: There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8\% in the tested group vs. 16.1\% in the untested group (RR = 0.61, 95\% CI = 0.39-0.95, p = 0.027), ED visit rate was 4.4\% in the tested group vs. 15.4\% in the untested group (RR = 0.29, 95\% CI = 0.15-0.55, p = 0.0002) and outpatient visit rate was 71.7\% in the tested group vs. 36.5\% in the untested group (RR = 1.97, 95\% CI = 1.74-2.23, p < 0.0001). The rate of overall HRU was 72.2\% in the tested group vs. 49.0\% in the untested group (RR = 1.47, 95\% CI = 1.32-1.64, p < 0.0001). Potential cost savings were estimated at $218 (mean) in the tested group. The provider majority (95\%) considered the test helpful and 46\% followed CDST provided recommendations. CONCLUSION: Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.
This article was published in J Med Econ
and referenced in Journal of Research and Development